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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by BobS, on September 27, 2004, at 19:28:05
jr,
In a thread above you say "I am very med-sensitive, especially in terms of the agitation side effect.The good news is that I have noticed very little agitation on cymbalta when comparing it to effexor. But for someone just starting it, you will notice quite a bit of start-up effects. Stick with it, most [if not all] will dissipate in the coming weeks."
I too am very med sensitive and desperately looking for help. One possibility is Cymbalta. Can you tell me your dx and total med history.
I am supposedly "harm avoidant OCD and atypical depression" that is now aggravated with major depression. I was on Paxil for years then quit for a couple and felt wonderful. Then my world crashed around me. I tried Zoloft and thought I would die from akathisia, etc. Then Remeron which pooped out. Now I'm back on Paxil which does not seem to working, so it is being augmented with Cytomel, which also does not seem to be working.
In any event I need an AD that will not cause me to jump out of my skin. Hopefully, you can shed some light on my prospects for Cymbalta by giving me some of your history and dx for comparison, especially the agitation and med sensitive part.
Kindest Regards,
BobS.
Posted by jrbecker on September 28, 2004, at 15:09:56
In reply to Anxiety ? for jrbecker, posted by BobS, on September 27, 2004, at 19:28:05
> jr,
> In a thread above you say "I am very med-sensitive, especially in terms of the agitation side effect.
>
> The good news is that I have noticed very little agitation on cymbalta when comparing it to effexor. But for someone just starting it, you will notice quite a bit of start-up effects. Stick with it, most [if not all] will dissipate in the coming weeks."
>
> I too am very med sensitive and desperately looking for help. One possibility is Cymbalta. Can you tell me your dx and total med history.
>
> I am supposedly "harm avoidant OCD and atypical depression" that is now aggravated with major depression. I was on Paxil for years then quit for a couple and felt wonderful. Then my world crashed around me. I tried Zoloft and thought I would die from akathisia, etc. Then Remeron which pooped out. Now I'm back on Paxil which does not seem to working, so it is being augmented with Cytomel, which also does not seem to be working.
>
> In any event I need an AD that will not cause me to jump out of my skin. Hopefully, you can shed some light on my prospects for Cymbalta by giving me some of your history and dx for comparison, especially the agitation and med sensitive part.
> Kindest Regards,
> BobS.
Dx: Atypical Depression with moderate anhedonic features, possible Bipolar II• My condition might also be described as "agitated" depression, or possible manifestation of "soft" Bipolar II features
• Other symptoms include mood reactivity, diurnal variation (peak of day for me is around 8pm), as well as rejection sensitivity (more so, when younger).
• I am very sensitive to low dosages of most meds, and find some of them intolerable (increasing atypical features and agitation) even at starting dosage levels. For example, I could not tolerate Lexapro at 10mg, Strattera at 40mg, or Focalin at 5 mg. It seems as I have gotten older, I tolerate meds even less. Somnolence, agitation, and sleep disruption are the 3 key adverse events I usually experience from most drugs. Irritability is also a significant side effect, but depends on the drug itself as well as the changing of the seasons.
Symptomology (1 to 10 scale): assessment reflects symptoms during a med-free period
10 being severest, 1 being mildest
Anhedonia 8
Hypersomnolence 7
Anorgasmia 7
Social Avoidance 7
Excessive guilt 7
Hyperphagia 7
Agitation/Irritability 6
Brain fog/Cog. dysfunction 6
Lack of focus/attention 6
Generalized anxiety 6
Sleep disruption 5
Impulsivity 5
Low Libido 5
OCD 3the only ssris I don't have experience with are luvox and paxil. It's been almost 10 years since I was on zoloft, but I do remember it being quite agitating. So unfortunately, I can't offer a comparison to Cymbalta. But in terms of a cymbalta v. effexor matchup, Cymbalta clearly wins for being less-agitation inducing. It should be noted that I do experience some agitation/jumpiness/akathesia on cymbalta, but this is mild in comparison to the Eff.
In terms of of antidepressant/anxiolytic efficacy, it's my own personal experience that cymbalta is superior to effexor and any of the SSRIs that I've tried.
Other possible augmentation strategies besides might be a low dose of klonopin, depakote, or risperdal. Or maybe Mirtazapine (15-30) or Serzone. Of course, these all have their own hook-ups. So you might want to give cymbalta a shot on its own for 3-4 weeks to see if you can get past the initial start-up adversities. Then maybe consider augmention.
Posted by BobS, on September 30, 2004, at 19:35:04
In reply to Re: Anxiety ? for jrbecker, posted by jrbecker on September 28, 2004, at 15:09:56
jr,
Thanks for the response. It appears we are treading water in a similar genetic pool.Based on your experience with Cymbalta, it will be my next trial. The anxiety and agitation are the killers in my world. I can will myself out of some of the symptoms of depression.
FYI - My meds are:
Paxil CR at 25 mg, just increased two days ago to 37.5
Cytomel 15 mcg
Xanax and Xanax XR varies from 2 mg or less to 4.5 mg when I am in a really bad state, such as starting up an SSRI.Thanks again.
BobS.
This is the end of the thread.
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